Limb vascular compromise:
Following any significant trauma to a limb whether it be blunt or penetrating, it is important to assess for any vascular compromise which may have occurred. Limb compromise may occur for several reasons due to trauma, for example from compartment syndrome, from tissues swelling, from main artery injury, etc. If there is evidence of vascular compromise, quick management in hospital is required to save the compromised limb. The 6 P’s mnemonic can be useful in identifying any vascular issues:
Pain – Pain which is out of proportion to the apparent injury may indicate ischaemic compromise as cells become hypoxic.
Pallor – The pallor of the limb may become grey, ashen, or discoloured as blood flow to the limb is compromised.
Paralysis – Loss of movement and control of the limb may indicate vascular compromise due to potential injury occurring to cause paralysis.
Paraesthesia – Changes in the sensation of the limb, again, potentially indicating vascular compromise caused through trauma or through a decreased blood flow.
Pulselessness – A loss of peripheral pulse indicates that blood isn’t flowing, meaning a loss of circulation.
Perishing cold – Where the limb is cold to touch, indicating that there may be poor/no blood flow through.
Bones can break and bend in a number of different ways:
Stable fracture – Where the bone breaks and the broken ends line up, barely out of place
Compound fracture – As discussed, where the bone breaks and penetrates the skin
Transverse fracture – Where the fracture follows a horizontal fracture line
Oblique fracture – Where the fracture follows an angled pattern
Comminuted fracture – Where the bone has broken into 3 or more pieces
Pathological fracture – Where the bone has broken due to pathological means, e.g., disease
Stress fracture – Where there is a hairline fracture in the bone
The following fractures occur in children:
Greenstick fracture – The bone bends but doesn’t fracture all the way through
Buckle fracture – Occurs where the bones compress into each other causing one side of the bone to bend
Growth plate fracture – Occurring at the joint where the growth plate is located, this can affect the development of the bone, causing it to be shorter than its’ opposite